Theories on Drug Abuse: Selected Contemporary Perspectives

A complete account of the causes of drug use and abuse must consider at least three groups of factors: physiological, social, and psychological. Furthermore, it must explain both grouped data (such as means and correlations between variables that are measured by normative tests) and individuals. No one theory is capable of including all relevant factors at both group and individual levels. Consequently, the research scientist or clinical diagnostician must be in a position to evaluate all possibilities, weighing each according to its probable significance for the problem at hand.

The theory of drug abuse presented here concentrates on psychological factors in chronic drug abusers. lt is personalistic in that it deals with individuals in all their complexity and uniquenesses. The ideas it contains are not "laws of behavior" but guides for understanding individual human beings.

This theory is also distinctive in that it calls special attention to the importance of the numinous aspects of human experience. "Numinous" means, roughly, spiritual and refers to the universal human tendency to construe the world and oneself animistically. ln cases of drug use and abuse, numinous factors become most obvious when substances are assigned magical or mystical properties by their users, when drugs are incorporated into religious rituals, or when such substances are the means for producing transcendental experiences (which the commonly used term "euphoria" is hopelessly inadequate to describe). Numinous factors operate in everyone's life, and it is important that they be recognized and understood.

Since 1974, the Greater Kansas City Mental Health Foundation has been engaged in a program of research on the relationships between drug use/abuse and lifestyle. The program uses the representative case method (Shontz 1965, 1976; Spotts and Shontz 1980) an approach to research that must not be confused with ordinary case-study techniques.
A representative case is not a sample of a population or a person of "unusual clinical interest," but an exemplar of a variable or type of behavior that is of specific theoretical or practical concern. For example, in a study of the effects and use of cocaine the ideal representative case is not a person who takes the drug occasionally for recreational use, but one who is a genuine expert on the substance, who is committed to its use and who has tried it at all dosage levels and by all forms of ingestion. This person must epitomize cocaine use as clearly as possible and must be studied extensively and intensively, using both quantitative and qualitative means. He must be treated not as a "subject" but as a "consultant" or, at the very least, as an equal partner in the scientific enterprise. Research of this type can serve exploratory purposes, but it also provides a powerful tool for testing hypotheses that have been developed in large-scale studies but have not yet been validated in individuals (Spotts and Shontz 1980).

lt is, perhaps, tempting to conclude that a method which advocates the study of "single cases" promises an easy or quick way to conduct research. Nothing could be further from the truth. First of all, it should be obvious that truly exemplary cases can be extremely difficult to locate. Hundreds of candidates may have to be screened before the appropriate individual is found. Second, data collection is long, arduous, and demanding because it involves not only days of intensive testing and interviewing but usually requires repeated evaluations over many months. Third, data analysis is complex and time consuming. Each subproject of the Greater Kansas City studies required factor analyzing nine correlation matrices of 15 variables each, nine correlation matrices of 27 variables each, 18 analyses of variance, each involving a complex, mixed model design, consisting of five factors, crossed and nested in most unorthodox fashion—all this to analyze a single type of data (Q-sorts). And these analyses constituted just a small part of what had to be accomplished to prepare the descriptions of each of nine representative cases. Finally, integration of cross-sectional and longitudinal, dimensional and morphogenic, qualitative and quantitative data, both within and between cases, poses a huge problem in data condensation, interpretation, and communication.

The research from which this theory was derived is based on the proposition that the intensive study of carefully selected individuals provides a unique perspective on the problems of drug abuse and, if properly conducted, yields as much information about specific drugs, their effects, dynamics and determinants of use, antecedents, consequences, and social correlates as more traditional methods.

This program of research has focused upon the intensive study of closely matched persons, each of whom had engaged in long-term use of cocaine, amphetamine or its congeners, narcotics, or barbiturates. The men were chosen from among hundreds of candidates because each was an expert who could speak with authority about himself as well as about his drug of choice, its effects, and the factors associated with its use. All were studied intensively and extensively with structured interviews and with dimensional and morphogenic tests.

Our theory draws heavily upon the germinal ideas of Carl G. Jung. lt is appropriate that this be the case, for Jung derived his theory from the intensive study of individuals. Like any theory, this one is anchored in the methodology from which it was derived. Therefore, it is almost certain to differ in significant ways from theories based upon other approaches, research methods, and data-collection procedures.

The theory has three parts: a conception of personal structure, a conception of how personal structure develops, and a framework for describing the drug experiences of chronic, heavy users of several substances.

PERSONAL STRUCTURE

Every person is a complex mediator between two realities: the external physical/social environment, on the one hand, and the internal psyche, on the other. An investigator who observes or studies another person starts in the environment and first encounters that other person's overt actions. By noting regularities of behavior, the observer draws inferences about the outermost layer of the observed person's total structure, the ego.

The relationship between a person's ego and the environment is that of figure and ground. ln the optimal state, the ego is clearly differentiated and maintains its integrity in relation to the environment. Too much expansion or contraction of the ego or too much effort either to transcend or to obliterate it is biologically maladaptive.

ln addition to describing a person's ego, the observer may draw inferences about deeper levels of the personal structure. The first level below the ego is the lifestyle: the consistent and pervasive pattern, system, or organization of preferences, regularities, and orientations that underlies overt behavioral adaptation. Lifestyle variables include those described in other theories by such terms as habits, traits, or defense mechanisms. However, the concepts of habit, trait, and defense mechanism do not take into account the patterning, organization, and hierarchic structuring that make the lifestyle a system rather than a simple conglomerate or profile.

At first glance, the lifestyle of a pimp obviously differs from that of a real estate agent. Yet at a deeper level, both pimp and real estate agent may share the same determination to be indomitable, to be the most successful at what they do. We call the next level of basic organizing principles from which the lifestyle and ego derive their character life themes. ln other theories, life themes might be called core conflicts, character structure, or dominant tendencies. However, most theories that rely on such constructs are content to consider them to be wholly learned and to be the most fundamental level of personal structure. According to this theory, neither is the case. For one thing, preprogrammed (archetypal) processes set the stage for learning of the life themes. For another, relations with the psyche by way of the personal myth are more basic than the life themes.

We found that most of our consultant-participants could be described in terms of no more than four to six themes. For example, one drug user's life is dominated by the determination to make a great scientific discovery that will justify his mother's faith that he is a genius. Another's is pervaded by efforts to gain love and attention from a powerful but affectionless father, while yet another's life is pervaded by the need to conquer women sexually in order to neutralize the power he feels they would otherwise have to emasculate him.

Finally, it became evident from our research that yet one more inferential step was necessary, for we discovered that, as Freud recognized

in his concept of repetition compulsion (1929), each man seemed to be living out a destiny over which he had little control. Thus, at the deepest level of inference lies the myth or numen that gives each person's existence a fate-like, an entelechial, quality as if possessed by life-shaping forces over which personal control is not possible. ln Jung's terms, the myth is the kernel or core of an "autonomous complex," a numinous, monadic formation that remains subliminal and operates according to its own inherent tendencies, independent of the conscious will. A well-integrated myth may be expressed in creative work. Poorly integrated into the rest of the personal structure, it may cause maladjustment (Jung 1971). The myth serves a purpose in human life that is equally important to that served by the ego. The function of the ego is to insure biological survival, and in modern society, that typically takes place by means of technological or economic achievement. The function of the myth is to insure wholeness or unity of the person. Like Janus, the two-faced god, each individual faces both environmental and psychic realities. A balanced responsiveness to both is necessary if equilibrium is to be maintained (Larsen 1976). ln a person who is functioning well, the ego insures biological survival by adapting to environmental realities, while the myth insures wholeness through insuring the ego's relatedness to psychic realities.

OPERATlONAL CONSlDERATlONS

Direct observations of behavior provide the basis for inferring ego structure. Psychological tests penetrate to at least the level of lifestyle. lntensive interviews and projective examinations usually permit reasonable reconstruction of life themes. However, discovery of another person's numen or myth requires not only a knowledge of the person but some familiarity with mythology as well as personal empathic and intuitional freedom on the part of the investigator. To insure reliability, therefore, it is desirable for the process of myth identification to involve more than one person.

NORMAL DEVELOPMENT

During the earliest years of life, the human infant is dominated by influences from the psyche, the most important of which is the image of the mother (a precursor of the anima archetype). Although the newborn infant is not totally helpless, human beings are born unfinished, unready to meet the world, and the child must spend some time in the psychic atmosphere of the parents, in a second womb, as it were, where it must rely heavily upon others for safety, security, and survival (Campbell 1949). This is the stage in which, at the level of myth, the elementary or nuturant mother predominates (Neumann 1972). After a year or so, ego tools (speech, ambulation, motor coordination) start to develop, and a stage of emerging individuality begins. At this point the normal mother takes on the function of transformation by helping the child break away from her and become an independent person. The child's first experience of the process of transformation is reminiscent of being born and is incorporated into the child's myth as a prototype of the theme of rebirth that may be activated later in life during religious or quasi-religious experiences.

Normally, at least for boys, the father enters the picture at this stage and eventually becomes a model according to which the child's personal

myth is elaborated in relation to the animus, or archetype of masculinity. lf the father is absent or provides an unsuitable model, the transforming mother may assume this function and become, in effect, the animus of her own anima. The result is confusion over sexual identity in the child. More typically, the transforming anima requires that the boy increase in competence to win her approval, while the father teaches the boy how to accomplish this and to displace the anima away from the biological mother to a more suitable woman. During these formative years, the child's life themes begin to take form.

At adolescence, the boy becomes initiated into adulthood and begins developing his own lifestyle, the ways in which he chooses to express his life themes. Adolescence contains an important danger point. At this time, tolerance for numinous experiences is diminishing, but the pressure from such experiences may not shrink sufficiently rapidly and the ego may not yet be strong enough to solve the problem realistically. This is the so-called adolescent crisis, and it is the culmination of a condition that develops from early childhood (Edinger 1973, pp. 3-36). After this crisis is passed, growth is for several decades a process of ego development and gradual alienation from numinous psychic influences.

At mid-life another phase begins. The now overdeveloped ego may become so estranged from its mythical roots in psychic experience that the person begins to feel a need for spiritual wholeness, for a meaning in life. During this period the person counteracts the growing sense of alienation by returning to inner experiences or spiritual and religious sources for support and reintegration (Edinger 1973, pp. 37-71). lf he is successful, the result is the emergence of a new, more complete identity called the self. This is the culmination of personal actualization; the process of self-development (called individuation) may continue for the rest of the person's life.

PATTERNS OF DEVELOPMENT IN CHRONIC DRUG ABUSERS

ln this section, we briefly describe the typical or modal developmental patterns that have emerged from our research with men committed to heavy or chronic use of amphetamine, cocaine, narcotics, or barbiturates. Although the developmental patterns of these relatively "pure" drug-user types show striking differences among groups, explainable variations and even occasional reversals of these modal patterns also appeared.

This discussion does not concern individuals who use drugs only for social-recreational purposes. Unlike recreational drug users, chronic drug users do not take drugs merely for pleasure. lndividuals who are committed to the heavy, long-term use of drugs do so to—

1. Fill gaps in their personal structure and mediate serious breaks between their rational (ego) and psychic (mythical) lives;

2. Attain by chemical means, even if only temporarily, ego states they cannot attain by their own efforts; and

3. Cope with ego deficiencies that have a developmental origin and handicap them in their efforts to achieve individuation.